Today, the Kaiser Family Foundation and the Georgetown University Center for Children and Families released their annual 50-state survey on Medicaid and CHIP eligibility, enrollment, renewal and cost-sharing policies. The survey is a “must read” report for anyone interested in health care policy and its impact on low-income children and families across the country. Tricia Brooks has been one of the lead authors of this report for the past six years and she shares her perspective on this year’s survey.
We always look forward to the release of the 50-state survey to see what you’ve learned. What were your top findings in 2016?
Tricia Brooks: During 2016 states continued to upgrade and streamline Medicaid eligibility and enrollment systems and processes under the ACA. Thirty-nine states are able to make eligibility determinations on some portion of applications in real time or overnight. At least 50 percent of applications receive a real-time determination in 15 of the 35 states that were able to report this data, including nine states that report more than 75 percent of applications receive a real-time decision.
The same progress is being made on streamlining renewals, with 42 states able to process automated renewals. Among the 38 states able to report the share of renewals that are completed through automatic processes, 19 report that more than half of renewals are automated, including 10 states with automatic renewal rates above 75 percent. Using data-driven processes to verify eligibility reduces the administrative workloads on states and eases the paperwork burden on applicants and enrollees as well.
Why is this 50-state survey important?
Tricia Brooks: This will be a pivotal year for health care coverage as Congress and the next president debate repealing the Affordable Care Act (ACA), consider major changes to the financing and structure of Medicaid, and face a pressing deadline to reauthorize CHIP funding. All of these policy decisions will have a major impact on the future of health care coverage for children and families.
Our report looks at the existing landscape and provides insight into how past policy decisions have impacted coverage for low-income children and families. The report also establishes a baseline against which future policy choices can be measured. This type of data is an important resource that can help state and national policymakers make informed decisions.
Why do Medicaid and CHIP programs vary so much from state to state?
Tricia Brooks: Medicaid and CHIP are federal-state partnerships, and no two state programs are exactly alike. The federal government establishes minimum standards but gives the states a lot of flexibility to design their own programs within federal parameters. For example, states set their own eligibility levels and decide what data sources they will use to verify eligibility. They also make key decisions such as whether to guarantee 12 months of continuous eligibility to children or eliminate the five year waiting period for lawfully present immigrant children.
Can you give us a few examples of states that are doing a good job of leveraging federal resources to improve health coverage options for their residents?
Tricia Brooks: The most impactful state policy decision since 2014 is whether states have chosen to expand Medicaid to more low-income adults to fill the coverage gap. States that have expanded Medicaid are covering more parents, which is good for kids. Additionally, the states that are using technology to verify eligibility through electronic processes rather than paper verification procedures are operating more efficiently.
Which states are missing out on the most opportunities to leverage federal funding to help their residents meet their health care needs?
Tricia Brooks: Some states could do more to advance children’s coverage. For example, only 24 states provide 12 months of continuous eligibility to children in Medicaid, a policy that can help reduce churn and facilitate how states measure the quality of care provided. Only 31 states have taken advantage of federal funds to extend coverage to recent immigrant children who are lawfully present. These examples illustrate how states have flexibility and can make policy choices that result in covering more children.
This survey is a heavy lift. Can you tell us a little bit about how you manage to pull it off every year?
Tricia Brooks: Each year, we review the prior year survey instrument to determine if we should add, drop or revise questions given the prior year’s results and the current policy landscape. We interview policy experts in each of the states and then compile and analyze the data to determine what we will publish. But before publication, we send each state a verification form to confirm that the data is accurate. It’s a team effort and requires a tremendous amount of precision and attention to detail given the number of data points collected and reported on a state level basis. Thankfully, we have a great team at KFF – Samantha Artiga, Elizabeth Cornachione and Petry Ubri – as well as the newest addition to the team from CCF, Karina Wagnerman, who rejoined the CCF staff after working at Mathematica on Medicaid and CHIP-related projects.